• Terrence Wong, Adam B Schlichting, Andrew J Stoltze, Brian M Fuller, Amanda Peacock, Kari K Harland, Azeemuddin Ahmed, and Nicholas Mohr.
• Terrence Wong is a medical student, Andrew J. Stoltze is a resident physician, Kari K. Harland is a biostatistician, and Azeemuddin Ahmed is a clinical professor, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Adam B. Schlichting is a clinical assistant professor, Department of Emergency Medicine and Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine. Brian M. Fuller is a clinical assistant professor, Department of Anesthesiology, Division of Emergency Medicine and Division of Critical Care, Washington University School of Medicine, St Louis, Missouri. Amanda Peacock is an advanced registered nurse practitioner, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. Nicholas Mohr is a clinical assistant professor, Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine.
• Am. J. Crit. Care. 2016 Mar 1; 25 (2): 173-7.

BackgroundOral chlorhexidine prophylaxis can decrease occurrence of ventilator-associated pneumonia. However, the importance of timing has never been fully explored.ObjectiveTo see if early administration of oral chlorhexidine is associated with lower incidence of early ventilator-associated pneumonia (within 5 days of admission to intensive care unit) in intubated air ambulance patients.MethodsA single-center, retrospective cohort study of intubated adults transported by a university-based air ambulance service and admitted to a surgical intensive care unit from July 2011 through April 2013. Primary exposure was time from helicopter retrieval to the first dose of oral chlorhexidine in the intensive care unit. Early chlorhexidine was defined as receipt of the drug within 6 hours of helicopter departure. The primary outcome was clinical diagnosis of early ventilator-associated pneumonia. Patients who were less than 18 years old, died within 72 hours of admission, or had pneumonia at admission were excluded.ResultsAmong 134 patients, 49% were treated with chlorhexidine before 6 hours, 84% were treated before 12 hours, and 11% were treated for early pneumonia. Early chlorhexidine (before 6 hours; 15%) was not associated (P = .21) with early pneumonia (8%). Furthermore, median times to chlorhexidine did not differ significantly (P = .23) between patients in whom pneumonia developed (5.2 hours) and patients with no pneumonia (6.1 hours).ConclusionsEarly administration of oral chlorhexidine in intubated patients was not associated with a reduction in the incidence of ventilator-associated pneumonia in a surgical intensive care unit with high rates of chlorhexidine administration before 12 hours.©2016 American Association of Critical-Care Nurses.

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